Customer Care Representative II

Important things YOU should know:

• Fully remote opportunity
• Training schedule 8:00am \- 4:30pm Monday – Friday CST for the 1st 12 weeks
• Work schedule (after training): Multiple opportunities available with ranging start times from 7:00am CST to 10:30am CST Mon \- Fri.
• Hours of operation: 7:00am \- 10:00pm CST Monday \- Friday so shift could flex based on business need
• $2\.00/hour differential on Mon/Tues
• Occasional evenings, weekends and holidays possible during Annual Medicare Open Enrollment: 10/1 \- 3/31
• Exceptional professional growth in a fun rewarding environment

Experience with Dental or Health insurance a preferred plus

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What will YOU be doing for us?

Our Customer Service Representatives must have strong problem\-solving skills, coupled with the natural ability to provide empathy for the customer – always taking the time to patiently listen and understand their questions to help find a viable solution, while providing them with a memorable customer experience.

What will YOU be working on every day?

• Servicing our Dental and Vision inbound callers with information regarding their eligibility, benefit coverage, authorizations, claims, and assisting them with locating a provider in their area,
• Utilize knowledge of claim adjustments and resubmission processes to determine appropriate resolution to provider requests.
• Provide feedback to Provider Relations staff on high\-level claim issues including but not limited to issues with reimbursement schedules or conflicting information to ensure providers receive a prompt resolution.
• Support enrollment activities including but not limited to assigning primary care providers, and updating third party insurance information.
• Act as liaison between our organization and the client’s Member Services staff to resolve issues such as eligibility and filing appeals and grievances.
• Provide updates to providers with questions regarding the status of their credentialing application.
• Recognize provider questions that could be handled through the use of the provider web portal and provide education to these callers on the benefits of utilizing the technology available.
• Ensure all calls are answered according to company and client guidelines.
• Accurately document call information and resolution in our internal systems.
• Apply effective diffusion techniques when necessary to ensure our customers feel heard, valued and supported.

Properly identify issues that need to be escalated appropriately to the leadership team.

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Additional Responsibilities:

• Provide recommendations on system enhancements and process improvements to management.
• Keep our Provider Relations team updated with provider manual discrepancies, change in locations or any other provider related issues.

Participate in departmental projects when applicable.

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What qualifications do YOU need to have to be GOOD candidate?

Required Level of Education, Licenses, and/or Certificates

• High school diploma or equivalent.
• Required Level of Experience

1\+ years of job related customer service experience within industries such as healthcare, call center, banking or retail.

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Required Knowledge, Skills, and Abilities

• Basic knowledge of Microsoft Office products including but not limited to Word, Excel, and Outlook.
• Ability to work occasional overtime as needed.
• Excellent listening and communication skills.
• Superior customer service skills including the natural ability to provide empathy.
• Strong data entry/typing skills.
• Strong navigation skills and the ability to multi\-task.
• Excellent attention to detail.

Critical thinking skills to quickly analyze and clearly understand a specific request or customer need and then leverage knowledge and resources to provide the appropriate solutions.

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What qualifications do YOU need to be a GREAT candidate?

Preferred Level of Experience

• 1\+ years of job related customer service experience within the dental, vision or medical industry.
• Previous experience working in a virtual environment.
• Understanding of dental, vision and/or medical insurance terminology.